João Borges-Costa

Clinical and Laboratory Features in Acute Generalized Pustular Psoriasis A Retrospective Study of 34 Patients

AbstractBackground: Acute generalized pustular psoriasis (AGPP) is a rare variant of psoriasis that can be lethal without proper treatment. It can be caused by the withdrawal of corticosteroids and, among its extracutaneous manifestations, liver abnormalities are frequently under-reported or attributed to drugs. Objective: The aim of this study was to assess the clinical and laboratory data, treatment options, and disease outcome in patients with AGPP and to search for significant differences between subgroups of these patients. Study Design: This was a retrospective analysis of the clinical files from inpatients with AGPP observed in our department between 1973 and 2008. Statistical tests were performed at a significance level of 5%. Setting: This was an inpatient, single-center study. Main Outcome Measures: Outcome measures were a previous history of psoriasis, corticosteroid use before admittance, mortality rate, white blood cell count, absolute neutrophil count, and abnormalities in liver enzymes. Results: Atotal of 34 patients fulfilled the inclusion criteria, of whom 61%were men and 65%had a previous history of psoriasis vulgaris. Topical corticosteroids were applied by 50%of patients before admittance. Skin lesions remitted with methotrexate, etretinate, or acitretin treatment in all but two patients who died of sepsis. Abnormalities in liver enzymes were present in 47%of patients. Patients without a previous history of psoriasis had a significantly younger age at the first episode of AGPP. In the comparison between the groups of patients with and without liver abnormalities, a male preponderance and higher leukocyte counts were found in the former, with a positive correlation between the absolute neutrophil count and total bilirubin also being observed. Previous use of retinoids or methotrexate was not associated with these hepatic alterations. Limitations: Limitations of the data were that this was a single-center, retrospective study with a small sample size. Conclusions: Withdrawal of systemic or topical corticosteroids can precipitate or worsen AGPP and these agents should not be used in these patients. Liver abnormalities can be considered an extra-cutaneous manifestation of AGPP. As in other series, no association between the use of drugs and changes in liver tests was found and therefore the deleterious withdrawal of efficient drugs, namely acitretin and methotrexate, should be avoided.

Sexually transmitted infections in pregnant adolescents: prevalence and association with maternal and foetal morbidity

Background  Pregnant adolescents have a high incidence of sexually transmitted infections and higher risk of adverse birth outcome.

Trichophyton erinacei skin infection after recreational exposure to an elephant in Southeast Asia.

Abstract Zoophilic fungal infections are a prevalent disease in tropical countries and clinicians must consider them in the differential diagnosis of pruritic skin lesions. We report a clinical case of Trichophyton erinacei skin infection after recreational exposure to an Asian Elephant. As far as we were able to search the literature, it is the first case described after contact with elephants

Secondary syphilis mimicking inflammatory bowel disease

This study reports the case of a 15-year-old male patient with extensive anal inflammation, cobblestone-like mucosa and areas of ulceration, loose bloody stool and weight loss for 8 weeks, suggestive of inflammatory bowel disease. Genital lesions of syphilides were later observed and Venereal Disease Research Laboratory test was positive, thus benzyl penicillin treatment was prescribed with total resolution of genital and bowel symptoms.

Median nail dystrophy associated with ritonavir

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Cutaneous Alternariosis Caused by Alternaria infectoria: Three Cases in Kidney Transplant Patients

The genus Alternaria has more than 80 species. Alternaria alternata and Alternaria infectoria are the most frequent species associated with infections in humans. Their clinical importance lies in the growing number of cases reported in immunocompromised patients. Herein, we report three cases of kidney-transplanted patients with different clinical presentations of cutaneous alternariosis and we discuss the treatment options.

Herpes simplex virus and cytomegalovirus co-infection presenting as exuberant genital ulcer in a woman infected with human immunodeficiency virus

In patients infected with human immunodeficiency virus (HIV), genital herpes can result in severe and atypical clinical presentations, and can become resistant to aciclovir treatment. Rarely, these manifestations may represent concurrent herpes simplex virus (HSV) with other agents. We report a 41‐year‐old black woman with HIV who presented with extensive and painful ulceration of the genitalia. Histological examination of a biopsy sample was suggestive of herpetic infection, and intravenous aciclovir was started, but produced only partial improvement. PCR was performed on the biopsy sample, and both HSV and cytomegalovirus (CMV) DNA was detected. Oral valganciclovir was started with therapeutic success. CMV infection is common in patients infected with HIV, but its presence in mucocutaneous lesions is rarely reported. This case exemplifies the difficulties of diagnosis of genital ulcers in patients infected with HIV. The presence of exuberant and persistent HSV genital ulcers in patients with HIV should also raise suspicions of the presence of co‐infection with other organisms such as CMV.

Recurrence of peripheral T-cell lymphoma as granulomas in the lower limbs

The presence of granulomas in the skin of T-cell lymphoma patients is a rare but well-known phenomenon. The authors present the case of a 44-year-old Caucasian male, with a previously treated peripheral T-cell lymphoma, with cutaneous infiltration and extensive dyschromia on his lower limbs. Skin biopsies revealed the presence of sarcoid granulomas associated with the recurrence of the lymphoma, confirmed by immunostaining and molecular analysis. Although a new scheme of chemotherapy was started, he died 18 months later. There are two different patterns of skin granulomas associated with lymphoma: granulomatous infiltrates admixed with neoplastic cells and cutaneous granulomas constituting a nonspecific manifestation of the underlying lymphoma, but presently there is no evidence supporting their relationship with lymphoma prognosis.

Progressive disseminated histoplasmosis as a presentation of AIDS in a patient from the Congo: the role of skin biopsy.

Progressive disseminated histoplasmosis is frequently fatal in HIV patients, and the standard diagnostic techniques can cause treatment delay. Skin biopsy can help in the differential diagnosis, allowing also an earlier treatment initiation.

Basal cell carcinoma in a 17 year‐old organ transplant recipient

Skin cancer is among the most frequent cancers in pediatric organ transplant recipients. We report a 17‐year‐old Caucasian girl who had had a kidney transplant 6 years before and was referred to our outpatient clinic for a basal cell carcinoma of the scalp. This case emphasizes the importance of teaching sun‐protective behavior to transplant recipients and their parents and having a high index of suspicion and arrange for early referral for dermatologic care if skin changes are observed.